Developing countries

Setting priorities for safe motherhood interventions in resource-scarce settings

Ndola Prata
Amita Sreenivas
Fiona Greig
Julia Walsh
Malcolm Potts
2010

Objective: Guide policy-makers in prioritizing safe motherhood interventions.

Methods: Three models (LOW, MED, HIGH) were constructed based on 34 sub-Saharan African countries to assess the relative cost-effectiveness of available safe motherhood interventions. Cost and effectiveness data were compiled and inserted into the WHO Mother Baby Package Costing Spreadsheet. For each model we assessed the percentage in maternal mortality reduction after implementing all interventions, and optimal combinations of interventions given restricted budgets of US$ 0.50, US$ 1.00, US$ 1.50 per...

Prevention of postpartum hemorrhage at home birth in Afghanistan

Harshadkumar Sanghvi
Nasratullah Ansari
Ndola Prata
Hannah Gibson
Aftab T. Ehsan
Jeffrey M. Smith
2010

Objective To test the safety, acceptability, feasibility, and effectiveness of community-based education and distribution of misoprostol for prevention of postpartum hemorrhage at home birth in Afghanistan. Methods A nonrandomized experimental control design in rural Afghanistan. Results A total of 3187 women participated: 2039 in the intervention group and 1148 in the control group. Of the 1421 women in the intervention group who took misoprostol, 100% correctly took it after birth, including 20 women with twin pregnancies. Adverse effect rates were unexpectedly lower in the...

Where There Are (Few) Skilled Birth Attendants

Ndola Prata
Paige Passano
Tami Rowen
Suzanne Bell
Julia Walsh
Malcolm Potts
2011

Recent efforts to reduce maternal mortality in developing countries have focused primarily on two long-term aims: training and deploying skilled birth attendants and upgrading emergency obstetric care facilities. Given the future population-level benefits, strengthening of health systems makes excellent strategic sense but it does not address the immediate safe-delivery needs of the estimated 45 million women who are likely to deliver at home, without a skilled birth attendant. There are currently 28 countries from four major regions in which fewer than half of all births are attended by...

Criticism of misguided Chu et al. article

Malcolm Potts
Caitlin Gerdts
Ndola Prata
Friday Okonofua
Nuriye Hodoglugil
Nap Hosang
Karen Weidert
Ashley Fraser
Suzanne Bell
2012

Chu, Brhlikova and Pollock’s article suggests the WHO rethink its decision to include misoprostol on the Essential Medi- cines List. Their paper is a sad example of workers in an elite setting advocating policies with the potential to endanger the lives of thousands of vulnerable women in low-resource settings.

Published in Journal of the Royal Society of Medicine 2012: 105(11), 454.

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Training traditional birth attendants to use misoprostol and an absorbent delivery mat in home births

Ndola Prata
Abdul Quaiyum
Paige Passano
Suzanne Bell
Daniel D Bohl
Shahed Hossain
Ashrafi Jahan Azm
Mohsina Begum
2012

A 50-fold disparity in maternal mortality exists between high- and low-income countries, and in most contexts, the single most common cause of maternal death is postpartum hemorrhage (PPH). In Bangladesh, as in many other low-income countries, the majority of deliveries are conducted at home by traditional birth attendants (TBAs) or family members. In the absence of skilled birth attendants, training TBAs in the use of misoprostol and an absorbent delivery mat to measure postpartum blood loss may strengthen the ability of TBAs to manage PPH. These complementary interventions were tested in...

Prevention of postpartum hemorrhage in low-resource settings: current perspectives

Ndola Prata
Suzanne Bell
Karen Weidert
2013

BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of maternal death in low-income countries and is the primary cause of approximately one-quarter of global maternal deaths. The purpose of this paper is to provide a review of PPH prevention interventions, with a particular focus on misoprostol, and the challenges and opportunities that preventing PPH in low-resource settings presents.

METHODS: Using PubMed, we conducted a review of the literature on the randomized controlled trials of interventions to prevent PPH. We then searched PubMed and...

Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date

Jeffrey Michael Smith
Rehana Gubin
Martine M Holston
Judith Fullerton
Ndola Prata
2013

BACKGROUND: Hemorrhage continues to be a leading cause of maternal death in developing countries. The 2012 World Health Organization guidelines for the prevention and management of postpartum hemorrhage (PPH) recommend oral administration of misoprostol by community health workers (CHWs). However, there are several outstanding questions about distribution of misoprostol for PPH prevention at home births.

METHODS: We conducted an integrative review of published research studies and evaluation reports from programs that distributed misoprostol at the...

New hope: community-based misoprostol use to prevent postpartum haemorrhage

Ndola Prata
Paige Passano
Suzanne Bell
Tami Rowen
Malcolm Potts
2012

The wide gap in maternal mortality ratios worldwide indicates major inequities in the levels of risk women face during pregnancy. Two priority strategies have emerged among safe motherhood advocates: increasing the quality of emergency obstetric care facilities and deploying skilled birth attendants. The training of traditional birth attendants, a strategy employed in the 1970s and 1980s, is no longer considered a best practice. However, inadequate access to emergency obstetric care and skilled birth attendants means women living in remote areas continue to die in large numbers from...

Making a Difference with Misoprostol: The Case of VSI

Ndola Prata
Pamela Norick
Shannon Bledsoe
Richard Lowe
Molly Moran
VSI
2014

Since Nigeria became the first country in the world to register misoprostol, there has been an explosion in global interest around the medicine. VSI is proud to have contributed to this body of work with its unique approach and pioneering misoprostol program.

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